The debate all began one year ago, in a lecture at my graduate school, Boston University. Are at-home HIV test kits ethical? Will they work? The presentation for the recently FDA-approved oral, at-home kits was given by an FDA employee, that was an integral member in the approval process. The audience was composed of public health and medical students, doctors, nurses, professors, and HIV counselors. As you can imagine, the argument was heated. There are many arguments for each side. Pro, more people may get tested, and with a positive test result, may practice safer sex, and may reduce transmission of the virus. Con, an HIV+ result comes with many psychological implications. Without proper counseling, people may not understand that, today, HIV is a treatable disease. With antiretroviral treatment, a healthy and prosperous life is still possible. I left the discussion leaning towards the con. I saw the beneficial guidance that HIV counselors could provide, at such an emotional and difficult moment, as an essential component to HIV testing.
Fast forward one year to now. After living in Malawi for six months, I think I have ‘flipped’ sides. Like most countries, worldwide, but especially in Africa, Malawi has had several ‘campaigns’ to increase the amount of people that go into health clinics, and take a free HIV test. These campaigns have been led by everyone, ranging from the national government, NGOs, churches, hospitals, and schools, yet, still, it is incredibly difficult to get most people tested. It seems like you can tell people all you want to ‘Go get tested,” but these statements of encouragement don’t tend to translate to higher test rates.
And you know what? After living here for six months, I know why. Because it is absolutely terrifying to get tested. You can make the testing centers as ‘patient friendly’ as you like, or do as many media campaigns as you want, but that can not take away how scary an HIV test is. It can not take away the fact that if you are young and sexually active in Malawi, you have a relatively good shot at being positive. Now, after several personal instances where this fact has been strikingly evident, I have decided that at-home test kits could work in Malawi.
Counseling is an integral part of HIV testing, but so is autonomy. I believe the basic need to feel safe and in control of your own life, overrules the initial need to be counseled. I believe at-home kits would give people more control of their situation, and the necessary time to self-reflect on a positive test result, disclose to family and friends, and then walk into the clinic when ready. I believe it would take some control away from external players, and give this control right to the individual.
There are still many other factors to discuss, and possible negative consequences to consider. Not to mention, the at-home tests do not give accurate results 100% of the time. Still, I think it is an issue worth exploring. I am happy, and willing, to hear more opinions about the implications, both positive and negative, at-home kits could have in Malawi.